South Street Dental LLC

South Street Dental LLC was paid $18K by Medicaid between Feb 2018 and Aug 2022, across 9 billing codes. Its largest line is D0120, dental checkup, returning patient — 26% of everything it billed.

33Billing provider infoSOUTH STREET DENTAL LLC
QUINCY, MA 02169

33aNPI1821479445assigned 06/10/2015

33bProvider typeDentist

28Total paid$18K

24GClaims571

24DCodes billed9

24AFirst – last monthFeb 2018 – Aug 2022

Compared with peers

Next to other Dentist providers in Massachusetts

Rank by total paid#279 of 413

Median peer was paid$93K

This provider vs. median0.2×

Peers share this provider's primary NPPES type and state. Size alone says nothing about billing quality: a big agency or a hospital system is expected to sit far above the median.

Box 24A · Dates of service

Paid by month

Paid that monthNov–Dec 2024: claims still arriving when the file was cut, so these months run low for every provider

By year, as a table

Year	Claims	Paid
2018	383	$12K
2019	100	$3K
2020	39	$1K
2022	49	$2K

Box 24 · Service lines

What it billed for

Code	Service	Share	Claims	Bene. records	Paid
D0120	Dental checkup, returning patientPeriodic oral evaluation - established patient	26%	181	180	$5K
D1208	Topical application of fluoride, excluding varnish	17%	113	111	$3K
D4910		16%	40	40	$3K
D1206	Topical application of fluoride varnish	14%	67	67	$3K
D1330		7.2%	97	97	$1K
D4381		7.1%	16	12	$1K
D1120	Dental cleaning, childProphylaxis - child	6.8%	26	25	$1K
D1110	Prophylaxis - adult	4.2%	15	15	$770.00
D0220	Intraoral - periapical first radiographic image	1.4%	16	16	$254.00

Claims and beneficiary counts add up across code × month rows, so one patient seen every month counts many times. Rows with fewer than 12 claims are suppressed by HHS, so small lines can be missing.

From NPPES

Who's on the registration

Authorized officialBIMBLI, EMA (OWNER)